First Name:

Last Name:

Address:

Home Phone:

Cell Phone:

Name, age and relationship of those residing with you.

Do you often have other people visiting your home?   Yes   No

Do you often have children in your home such as your children, grandchildren or, other children?
Yes   No

Is everyone in the residence and family agreeable to adopting a Dachshund?
Yes   No

Have your children (if applicable) been exposed to Dachshunds?
Yes   No Not Applicable

Teach everyone in your home, children and all visitors, the proper care and treatment of your new dog?
Yes   No

Always monitor young children with your new dog?
Yes   No

Research the Dachshund breed to better understand their special characteristics and needs?
Yes   No

Take the dog to a veterinarian at least once a year for a physical exam?
Yes   No

Take the dog to a veterinarian when ill? Yes   No

Take the dog for obedience training if needed? Yes  No

Welcome the dog into your family as a permanent member? Yes   No

Return the dog ONLY to the Las Vegas Hot-Diggity Dachshund Club and Rescue if you decide he/she cannot be a member of your family?
Yes   No

Do everything within your power, and with the help of your veterinarian, and/or other professionals to ensure that the dog has a long, healthy life?
Yes   No

Financial obligations of responsible pet ownership? Yes   No

Special needs, time and patience involved with rescue dogs? Yes   No

Who will care for the dog and where will the dog be kept?

Do you have a exercise program for the dog? Yes  No

Have you ever owned a dog? Yes   No

Have you ever owned the Dachshund Breed before? Yes   No

Why do you want to adopt a rescued dog at this time?

Do you currently own any other dogs? Yes   No

Do you currently own any cats? Yes   No

If you do own any other pets, please provide the name, breed, species and age of each:

Have ALL the animals listed above (if any) been spayed or neutered?
Yes   No    Not Applicable

If you have previously owned dogs, what happened to those no longer living with you?

What do you know about the characteristics and personality of the Dachshund Breed?

Are you aware that purebred Dachshunds can have a predisposition to back problems, weight gain, and house training problems and may not be the best choice for families with small children?
Yes   No

When adopting a Dachshund, what ages are you willing to consider?
Puppy     1-3 Years      4-6 Years      7-10 Years      Over 10 Years

Would you consider adopting a pair of dogs in the case that two dogs shouldn't be separated and need to be placed together?
Yes  No

Abused? Yes   No

Not reliable with children? Yes   No

Handicapped? Yes  No

Needs ongoing medication? Yes  No

Requires continued house training? Yes  No

Type of residence? House    Condominium    Apartment

Own or Rent? Own    Rent   

If renting, is your landlord agreeable to you having a rescued Dachshund?
Yes   No    Not Applicable

If you have a yard, is it fenced?   Yes   No    I don't have a yard

If you have a swimming pool or spa, is it saftey fenced or does it have an alarm?
Saftey Fenced   Alarm     Both    Neither    I don't have a pool/spa

Are there stairs in your residence? Yes  No

Where will the dog be kept during the day? 

How many hours a day will the dog be left home alone?

Where will the dog sleep?

Who will take care of the dog while your at work?

If needed, how will you housebreak the dog?

Please List Your Preferences: (Check all that apply)

Color:  Red    Black and Tan     Other

Coat:   Smooth    Long    Wire

Gender:   Male   Female

Anything you would like to add that would help in determining the correct animal for your living situation?

Landlord: (If applicable)

Veterinarian:

Reference 1:

Reference 2:

Reference 3:

Note: Failure to provide telephone numbers for landlord (if applicable), veterinarian and references will result in your application being delayed. If none please explain why.

If you are not chosen for the specific dog you are interested in, would you like to be notified of other Dachshunds who come into rescue that meet your requirements/preferences?
Yes  No